Breast Surgery

Dr. Selvi Radhakrishna was the first in South India to introduce and validate sentinel lymph node biopsy in early stage breast cancer in 2007. Since then she has performed over 600 sentinel lymph node biopsies with excellent results.Sentinel lymph node biopsies where applicable, reduces the risk of arm related complications like lymphoedema, thus enhancing quality of life after breast cancer treatment.

At Chennai Breast Centre we offer a range of surgical procedures for cancer of the breast and benign breast conditions.Breast cancer surgery is the main component of breast cancer treatment that involves removing the cancer with an operation. The surgery could be just removal of the lump or removal of the entire breast along with the axillary nodal assessment or clearance. Reconstruction may be offered along with the primary procedure or as a delayed procedure at a later date.Breast cancer surgery may be used alone or in combination with other treatments, such as chemotherapy, hormone therapy, targeted therapy and radiation therapy.

Breast conservation surgery is an alternative to remove the whole breast (Mastectomy).The cancerous lump can be removed with a margin of normal tissue around it (called wide local excision or lumpectomy). This leaves the majority of the breast untouched (breast-conserving surgery).Type of the cancer, size of the lump, size of the breast, multiplicity of the tumour, location of the tumour, lymph nodal involvement, access to follow up treatment with radiotherapy, access to follow up care are some of the factors that influence the choice of surgery (ie Breast conservation surgery or Mastectomy) Breast-conserving surgery is usually followed up with radiotherapy to the breast.

Other treatments like chemotherapy or hormone therapy are not influenced by the choice of surgery. The need for chemo or hormone therapy is usually based on factors such as tumour size, nodal status, grade, hormone receptor status, Her2 and Ki67 scores, age and physical condition of the patient.

Facts at a glance

Surgery time: 1-2 hours

Hospital stay: Same day discharge or 1 night stay in hospital

Anesthetic assessment: Yes, you will meet the anesthetist prior to surgery

Blood transfusion: No

Pain killers: for about 2 weeks

Antibiotics: Not routinely

Confined to bed: No

Up and walking: Same day

Full recovery: 2-3 weeks

Time off work: 2-3 weeks

Bras: Sports Bra after removal of the first dressing in 3 days.

Possible secondary surgery: 5% of patients may require a revision of margins if they are found to contain tumour cells

Chemotherapy: If required, will be started 3 or 4 weeks after surgery.

Radiotherapy: If there is no indication for chemotherapy, then radiation to the breast start 4 to 6 weeks later. If chemotherapy is essential then radiation is planned after the chemotherapy cycles are completed.

Where breast conservation is feasible, the long-term outcomes are comparable with mastectomy in terms of survival.

2. Mastectomy

A mastectomy is a procedure by which all of the breast tissue is removed during surgery. Most of the skin, nipple and areola will be removed along with the breast tissue. If reconstruction is planned simultaneously, then skin and sometimes the nipple and areola may be preserved and used to reconstruct the breast.

Along with the removal of breast tissue, some or all of the axillary lymph glands are also removed if they have cancer cells in them. (Sentinel lymph node biopsy / Axillary clearance)

Facts at a glance

Surgery time: 1-2 hoursHospital stay: Same day discharge or 1 night stay in hospitalAnesthetic assessment: Yes, you will meet the anesthetist prior to surgeryBlood transfusion: NoPain killers: for about 2 weeksAntibiotics: Not routinelyConfined to bed: NoUp and walking: Same dayDrains: Yes, usually for 1 to 2 weeks.Full recovery: 2-3 weeksTime off work: 2-3 weeksBras: Comfortable clothes initially. Latex breast prosthesis may be used after the first dressings are removed.Chemotherapy: If required, will be started 3 or 4 weeks after surgery.Radiotherapy: If there is no indication for chemotherapy, then radiation to the breast start 4 to 6 weeks later. If chemotherapy is essential then radiation is planned after the chemotherapy cycles are completed.

Following surgery, the tissues that are removed are again sent for detailed pathological analysis. Based on the information we get from this analysis, further chemotherapy, hormone therapy or radiotherapy are planned.The choice of lumpectomy or mastectomy might influence the need for radiotherapy. The decision regarding the need for chemotherapy and hormone therapy after surgery is usually based on the post-surgery pathology report and is independent of the nature of surgery (i.e) lumpectomy or mastectomySurvival outcomes are identical for both lumpectomy and mastectomy. But lumpectomy may not always be possible in all patients.

3. Sentinel lymph node biopsy/ Axillary clearance

Along with either a Mastectomy or a Lumpectomy axillary assessment/ treatment is carried out during surgery. Sentinel lymph node biopsy is a procedure which selectively removes the first draining lymph nodes in the armpit.These nodes are identified by using radioactive isotope or blue dye injected into the breast. These nodes are then sent for pathology examination by a technique called frozen section. The results are usually available within 30 minutes. If they are found to contain tumour cells then the rest of the axillary nodes may be removed.

If sentinel lymph nodes do not have cancers cells, then no further removal of axillary lymph nodes is required. This procedure is safe and effective for disease control and prevents complications such as arm stiffness and arm swelling (lymphoedema) that may occur otherwise.

4. Oncoplastic surgery

Oncoplastic procedures are sometimes done to improve the cosmetic outcomes of breast preserving operations. The breast volume that is lost after a lumpectomy can be replaced by muscle tissues from the back to maintain the shape of the breast. Sometimes the breast after a lumpectomy can be reshaped with the remaining breast tissue to give better cosmetic outcomes. This may involve reducing the breast size in very large breasts or a breast lift in sagging breasts. These procedures not only remove cancer but reshape the breast to look better. The opposite breast may also require a breast lift or a breast reduction to keep both the breasts symmetrical.Sometimes tissue from the back or the sides may be moved to the breast to achieve better cosmetic results. In general oncoplastic procedures may take additional surgical time and may need longer time to recover from surgery. The location of the tumour, size of the tumour, breast size and droop influences the choice of the procedure.

5. Chemo port insertion

A chemoport is an access point made on the chest or arm of patients to assist intravenous (IV) chemotherapy. Chemoport involves placing a device under your skin that gives vascular access for IV therapies and injecting contrast materials for scanning tests. This placement provides easy access to your blood stream.

TESTIMONIALS

"Battling cancer is hard enough. At first, my husband and I were very concerned about where we were going to receive treatment in my fight for survival. After talking with the doctor at CBC, we knew that"